Download soft tissue coverage of the upper limb

SOFT TISSUE COVERAGE
OF THE UPPER LIMB
PEDICLED MUSCLE and
FASCIO-CUTANEOUS FLAPS
AC Masquelet Mars 2007
DIU chirurgie de la Main
Présenté par M. Beustes-Stefanelli
HISTORIC OF FLAPS
• WOOD (1863)
• TANSINI (1892)
• ESSER (1917)
• LITTLER (1953)
• Mc GREGOR (1972)
• OLIVARI (1976)
SKIN VASCULARISATION
• MICHEL SALMON
- «!Les Arteres de la
Peau!»! (1936)
SKIN AND FLAP VASCULARISATION
ADVANCES 1980-2000
• DISTALLY-BASED
FLAPS (1981)
• ANATOMY
• VENO and NEURO
CUTANEOUS FLAP
• ADIPO-FASCIAL
PEDICLED FLAPS
• COMPOSITE FLAPS
REPAIR OF THE UPPER LIMB
THE PAST
SOFT TISSUE COVERAGE
and UPPER LIMB
• FEW INDICATIONS OF FREE FLAPS
• NUMEROUS POSSIBILITIES OF
PEDICLED FLAPS
• JOINTS MOTION and TENDONS
COURSE require SKIN FLAPS and
FASCIO-CUTANEOUS FLAPS
PEDICLED FLAPS for the UPPER LIMB
• THE «!TREE!» OF
THE FLAPS FOR
THE UPPER LIMB
SHOULDER GIRDLE
•
•
•
•
LATISSIMUS DORSI FLAP
PECTORALIS FLAPS
SCAPULAR FLAPS
POSTERIOR ARM FLAP
ANATOMY of the SHOULDER GIRDLE
THE «!KING!» DONOR SITE
FOR ISOLATED, ASSOCIATED
AND COMPOUND FLAPS
•
•
•
•
BONE
SKIN
FASCIA
MUSCLE
LATISSIMUS DORSI: THE «!KING!»
VASCULARISATION
TYPE V ACCORDING
THE CLASSIFICATION
OF MATHES AND
NAHAI
LATISSIMUS DORSI : TECHNIQUE
LATISSIMUS DORSI
• ARC OF
ROTATION OF
THE MUSCLE
UPROOTED LEFT UPPER LIMB
TIKHOFF PROCEDURE
TIKHOFF PROCEDURE
COMPOUND DEFECT
COMPOUND TRANSFER
SCAPULAR FLAPS : ANATOMY
• POSTERIOR
CIRCONFLEX
ARTERY
SCAPULAR FLAPS: TECHNIQUE
• INDICATIONS:
- REPAIR OF THE
ARMPIT
PARASCAPULAR FLAP
SCAPULAR FLAP
POSTERIOR ARM FLAP
SKIN ARTERIAL
BRANCH FROM
VASTUS MEDIALIS
POSTERIOR ARM FLAP
PECTORALIS MUSCLES FLAPS
PECTORALIS MINOR
ARC OF
ROTATION
PECTORALIS MINOR
PECTORALIS MINOR
COVERAGE OF THE
ELBOW
•
•
•
•
•
LATERAL ARM FLAP
BRACHIO-RADIALIS
POSTERIOR INTEROSSEOUS FLAP
LATISSIMUS DORSI FLAP
ANTECUBITAL FLAP
ANTECUBITAL FLAP
LATISSIMUS DORSI FLAP
LATISSIMUS DORSI FLAP
CHINESE FLAPS
SHANG-TI-SHEN
RUYAO SONG
• 1982
YANG KUO-FAN
LATERAL ARM FLAP: ANATOMY
LATERAL ARM FLAP: TECHNIQUE
• INDICATIONS:
- COVERAGE OF
ANTERIOR AND
POSTERIOR
ASPECTS OF THE
ELBOW
LATERAL ARM FLAP IN EXTENSIVE
ARTHROLYSIS OF THE ELBOW JOINT
COVERAGE OF HAND AND
WRIST
•
•
•
•
•
RADIAL and ULNAR FLAPS
POSTERIOR INTEROSSEOUS FLAP
DISTAL ULNAR FLAP
ANTERIOR INTEROSSEOUS FLAP
PRONATUS QUADRATUS FLAP
• GROIN FLAP !
RADIAL FOREARM FLAP
RADIAL FO REARM FLAP
• INDICATIONS:
- COVERAGE OF
THE DORSUM OF
HAND AND
FINGERS
RADIAL FOREARM FLAP
• ARC OF
ROTATION IS
INCREASED BY
DECROSSING THE
TENDONS
RADIAL FOREARM FLAP
• EXTENDED NECROSIS
BY ANTIMITOTIC
AGENT
• ITERATIVE EXCISION
• COVERAGE BY A
«!!CHINESE!» FLAP
• MP ARTHROLYSIS
• TWO-STAGES
RECONSTRUCTION of
EXTENSOR TENDONS
RADIAL FOREARM FLAP
ULNAR FOREARM FLAP
NEW INTEREST !
VERY LONG
PEDICLE !
RADIAL FOREARM FLAP WITHOUT
RAISING THE RADIAL ARTERY
POSTERIOR INTEROSSEOUS FLAP
ANATOMY
POSTERIOR INTEROSSEOUS FLAP
SEQUELLAE OF BURNS
SEQUELLAE OF BURNS
PIO FLAP and 1st WEB
POSTERIOR INTEROSSEOUS FLAP
• PROXIMALLYBASED FLAP
• SMALL DEFECTS
THE POSTERIEUR INTEROSSEOUS
FLAP FOR COVERING THE ELBOW
OSTEO-CUTANEOUS DEFECT ON THE
ULNAR SIDE
DISTAL ULNAR FLAP
• INDICATIONS:
ULNAR and DORSAL
ASPECTS of HAND
and WRIST
PRONATUS QUADRATUS FLAP
• FEW INDICATIONS
GROIN FLAP
• COVERAGE OF
ELBOW, FOREARM,
HAND AND WRIST
PEDICLED GROIN FLAP
SOFT TISSUE REPAIR OF
THE UPPER LIMB
• CONCLUSIONS:
- LATISSIMUS
DORSI and GROIN
FLAP CAN BE
USED IN THE
MAJORITY OF
THE DEFECTS